POS0908 AUDIOLOGICAL DISTURBANCES IN PATIENTS WITH SYSTEMIC SCLEROSIS: ASSOCIATION WITH CLINICAL MANIFESTATIONS AND NAILFOLD CAPILLARY MICROSCOPIC ABNORMALITIES
Authors: C. Mazeda, S. P. Silva, J. Romão, D. Matias, R. Aguiar, L. Azevedo, A. Barcelos
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic Sclerosis (SSc) is a rare connective tissue disease with several systemic and organ specific manifestations, characterized by immune dysfunction, vascular abnormalities, and fibrosis. The microvascular damage is a prominent feature of SSc, being easily assessed by nailfold video-capillaroscopy (NVC). These vascular changes may result in the involvement of the inner ear as the cochlea is highly sensitive to these changes. Blood changes and hypoxia seem to culminate with necrosis of the cochlear tissue, which is clinically expressed as hypoacusis and tinnitus. Hearing loss and auditory symptoms have been reported in 20 to 40% of SSc patients. The prominence of other symptoms may be a reason for audiovestibular symptoms being neglected in these patients, but this can negatively affect patient’s quality of life (QoL) and social interaction. Objectives The aim of this study is to assess the prevalence of audiological disturbances in patients with SSc and to evaluate its relationship with the duration, characteristics, and severity of the disease. Methods Cross-sectional study included 24 patients with SSc, who fulfilled ACR/EULAR criteria followed at outpatient rheumatology clinic between 2012 and 2020 and 20 healthy controls. Socio-demographic, clinical data and pattern of NVC were collected. Both groups underwent a complete ear-nose-throat physical examination, pure-tone audiometry, speech audiometry and impedance. QoL was assessed by the European Quality of Life–5 Dimensions (EQ-5D) questionnaire. Descriptive analysis was performed, p-value &lt;0.05 was statistically significant. Results Clinical characteristics and audiometric findings of all patients are listed in Table 1. 13% of patients with SSc reported hearing loss and 38% reported tinnitus and vertigo. Similar values were reported in control group with exception to vertigo symptoms (20%). 37.5% patients presented abnormal hearing loss in the pure-tone audiometry compared with 5% of the controls (p=0.02). Sensorineural hearing loss and abnormal speech reception threshold were more common in SSc patients compared to controls (p=0.03; p=0.04). Auditory recruitment was found in 1 SSc patient. There was no correlation between objective hearing loss and type of scleroderma, duration of disease, type of antibodies, skin score, NVC patterns and organ involvement but there were statistically significant differences with history of digital ulcers. We also found middle ear dysfunction: absence of stapedius reflex (20.8%) and abnormal tympanometry (45.8%) in patients with SSc versus control group (p=0.001). The mean value of EQ-VAS was lower in SSc group (63.8±13.1) compared to controls (71.1±11.0) (p=0.04), but without significant differences with the changes in the pure-tone or speech audiometry. Table 1. Clinical characteristics and audiometric findings of all patients SSc n=24 Controls n=20 p Age, years (mean±SD) 58.4±11.4 55.3±10.3 0.63 Sex (M/F), n 5/19 6/14 0.49 Duration disease (mean±SD) 50.3±41.2 - Diffuse cutaneous, n (%) 7 (29.2) - Anti-Scl70 antibody, n (%) 6 (25.0) - Anticentromere antibody, n (%) 14 (58.3) - Anti-RNA polymerase III antibody, n (%) 3 (12.5) - Pulmonary involvement, n (%) 7 (29.2) - Gastrointestinal involvement, n (%) 8 (33.3) - Articular involvement, n (%) 2 (8.3) - Nailfold video-capillaroscopy pattern - - Nonspecific 1 (4.2) Early 11 (45.8) Active 8 (33.3) Late 4 (16.7) Subjective hearing loss, n (%) 3 (12.5) 3 (15) 0.58 Tinnitus, n (%) 9 (37.5) 4 (20) 0.41 Objective hearing loss, n (%) 9 (37.5) 1 (5) 0.02 Sensorineural hearing loss (%) 7 (29.2) 1 (5) 0.03 EQ-VAS (mean±SD) 63.8±13.1 71.1±11.0 0.04 Conclusion Our study found higher prevalence of inner and middle ear pathologies in SSc patients. It is also important to emphasize the relationship found with history of digital ulcer. In these patients, this type of involvement should be considered both during diagnostic and therapeutic procedures. Further investigation is needed for a better understanding of ear damage in these patients. Disclosure of Interests None declared